Medical Science is full of acronyms - here is a list of those commonly used on this site!

BMD - Bone Mineral Density - A measure of bone health that compares your bone density, or mass, to that of a healthy person who is the same age and sex as you are.

DXA - Dual Energy X-ray Absorptiometry - commonly used method of determining bone density using two x-ray beams of relatively low and differing energy levels to assess the capacity of the bone to attenuate the beams.

FS - Fragility Score - a measure of bone quality and fracture risk available through REMS

REMS - Radiofrequency Echographic Multi Spectrometry - an ultrasound-based method of assessing bone density and quality.

ROI - Region of Interest - where the bone health is assessed - generally the spine and hips.

QUS - Quantitative Ultrasound

BH@SOS is an organization of professionals providing quantitative assessment of the properties of bone that are associated with fracture risk. BH@SOS examiners assess bone by means of pulsed echographic ultrasonography known as REMS TM – a method that complies with the standards established by the World Health Organization for bone assessment. All BH@SOS examiners are trained on the use and are equipped with the mobile EchoS TM platform allowing for onsite densitometry and fracture risk assessment. 

An assessment performed at OsteoStrong by BH@SOS is the same as a bone assessment performed in a doctor’s office. Your examiner will use REMS technology to assess your spine and left and right hips to generate two values that are critical to your bone health: These numbers are:

(1) Fragility Score - FS

(2) Bone Mineral Density - BMD

Historically, Bone Mineral Density (BMD) has been the number that was used to determine if you were at risk of sustaining a fragility fracture. However, it is now recognized that BMD is not the only important number because there are individuals with low BMD that never fracture and there are other individuals who sustain fragility fractures and have good BMD. Research is showing that there are other properties of bone that need to be measured. The important bone equation is: 

Strength = Bone Quality & BMD

Fragility Score (FS) is a measure of bone quality that BH@SOS will determine using REMS and it can help you have a better understanding of your risk of a fragility fracture. Also, there is a third bit of information that the REMS assessment will provide. This is:

(3) Body Composition and Estimated Activity Metabolism

The information provided by the Body Composition Analysis may provide useful information for a comprehensive weight loss program. The results obtained BH@SOS examinations are clinically valid and can be used in your bone health care.

REMS is a novel technology that targets specific bones with pulsed ultrasound waves and analyzes the backscatter radiofrequency (RF) signals from the insonified bone It has been established that the raw backscatter RF contains relevant information after interacting with the targeted bone microarchitecture. Therefore, the underlying principle of the REMS analysis is that the backscatter RF signals that have interacted with the bone contain information on both density and quality. In other words: REMS will produce a sound wave that bounces off your bones and makes an echo. REMS will then listen to the echo and be able to determine what is going on with your bones. It can do that because an echo from a strong bone will be different than an echo from a weak bone. 

The answer is ……a definite maybe! Obviously, all provider-patient relationships are different and depend not only on the provider and the patient, but the type of relationship you can have with your provider often depends on the setting where the healthcare is being delivered. In the body of this post we hope to provide insight into what we as providers consider when we review information that a patient has brought to us. We want to offer some suggestions on how to encourage and increase the likelihood that your provider will read what you have provided to them.

Know thy provider!!!!! - Everyone is different and you probably will already know whether or not your provider is amenable to receiving information from patients. If it is not your provider’s style to be receptive - don’t push the issue because it will not work and it may just set up feelings of frustration and possibly even unnecessary animosity which is counter-productive to any provider-patient relationship. Let it go and look for other options!

Respect your provider’s time!!!! - Even if your provider is willing to look at information that you bring in in order to help you determine if it is reasonable and even possibly beneficial for you it will take up time. Time is a problem in our modern health care system - modern medicine has had to become a “lean and mean fighting machine.” As insurance reimbursement levels continue to fall (isn’t it amazing that insurance premiums don’t ever seem to go down) in order to stay open medical practices have to be “efficient”. Your provider has mandatory objectives that need to be completed during your visit in order to “close the loop” that include identifying your medical issue, addressing it and providing treatment all within in either 10, 15 or 20 minutes, whatever time your provider’s business overlords have allotted (very few providers are in their own practices). After they have completed your visit, they have 20-30 more visits to complete! You may have to book additional time (the question is whether insurance will pay for that time) to discuss an educational issue in any significant detail.

Understand that your provider may be skeptical of internet-based information that you bring in order to help keep you safe!!!!! - The internet is fantastic in many ways and there is a wealth of knowledge just a click away! However, there are also scams, misinformation and deceptive practices flourishing, often dressed up to look legitimate and wholesome. When your provider reviews something that you bring in, there should be a level of caution on their part. However, providing patients with education is a big part of the healing process so your provider should be willing to critically evaluate what you have brought them and realize that you are bringing to their attention because it is IMPORTANT TO YOU. You may want to even point out how important it is to you for them to evaluate what you have brought to them and that you really respect their opinion - otherwise you wouldn’t be putting your health into their hands!

Understand what “standards of care” means and implies!!! - How a provider practices is based on her/his knowledge-base which is a composite of education/school, training and experience. However, “standards of care” are the region specific medical care standards practiced by surrounding providers in similar practice situations. Obviously, the “standards of care” will be different between a University Medical Center and a small community hospital. However, both “standards” should still deliver an acceptable level of health care. In order to maintain practice with an accepted “standard of care” a provider may stay with acceptable methods of providing care and not venture out of that “standard of care” comfort zone. Cutting edge is often what brings about innovation in health care but it is possibly a risky proposition - that goes back to the premise that it is your provider's responsibility to keep you safe. In regards to our topic - DXA is considered “standard of care”; REMS has not yet achieved that designation (but we are working on it!)

Show your provider that you respect their advice and recommendations, but if you disagree, tell them why you don’t agree and what alternative plan you would prefer that they consider. Be sure to be able to explain your opinion and having a valid reference at hand will go a long way!!!! Understand that your provider wants to keep you safe, but they also want to provide the highest level of healthcare that they can in - in 10 minutes. (Isn’t that absurd? But it is what it is and it’s the challenge that you and your provider need to overcome.) Ultimately, your health care is your decision! Ask your physician to partner with you and offer their guidance. This is not an unreasonable request to make to your provider. For example, every so often there will be a patient in my ortho practice who declines a cast. If splinting is a reasonable alternative, then I will explain to the patient why I think that casting is a better treatment choice; discuss explicit instructions for splint use and document the patient’s preference in the medical record, as well as their statement of understanding of risks and declination of my recommendations, and then apply the splint and continue to monitor their progress. In most cases, it’s not a big deal - but sometimes it may be so it has to be case-by-case!

With REMS, since many providers know nothing about it, you will have to be knowledgeable. Make sure that you understand the results of your report and the specific information that REMS provides that DXA does not (Fragility Score). To assist you in this challenge, the second portion of this post is an outline of the major properties of REMS with included references. If your provider is willing to accept it, or better yet to look it over in your presence, that may be the first step in the process of breaking through their first line of defenses and possibly raising their curiosity. You can only hope!